Substance Abuse (Alcohol, Smoking, Drugs) (1)

Question 1

Stimulants:
Where do changes occur in Cocaine addiction?

How do Amphetamines present?
→ How does its withdrawal present?
→ How is it managed?
→ What is Crystal meth?

What is MDMA (Ecstasy)?

How does an overdose of these substances present?
→ How is it managed?

Answer 1

➊ Mesolimbic pathway, more specifically the Nucleus Accumbens

➋ Similar to Hypomania i.e. elevated mood, over-talkativeness, increased energy, insomnia, HTN and pupil dilation
→ Depression, fatigue, suicidal thoughts, cravings
→ Benzodiazepines, Antipsychotics and Anti-depressants
→ Very addictive form that reaches high concentrations in the brain when smoked

➌ Synthetic Amphetamine analogue with mild stimulatory and hallucinogenic effects - “Safer” than cocaine or amphetamines

➍ Dilated pupils
→ Cooling, antihypertensives e.g. nitroprusside or GTN

Question 2

Opioids:
What are some examples?

What are the effects of it?

What are the signs of OD?
→ What is used to reverse the effects? When is it given until?

When are pts at high risk of OD?

When does withdrawal occur?
→ What are the signs of it?
→ How is it managed?

Answer 2

➊ Heroin, Fentanyl, Morphine, Codeine

➋ Euphoria, analgesia, drowsiness, resp depression, bradycardia, pupil constriction, constipation

➌ Pinpoint Pupils, Respiratory depression, Bradycardia, Hypotension
→ Naloxone - Given until good, spontaneous ventilation

➍ Following detox as they want to avoid the withdrawal effects

➎ 8-12hrs after last dose, lasting~10 days
→ ‘Cold Turkey’ – Pupil Dilation, Craving, Restlessness, Myalgia, Sweating, Abdo Pain, Tachycardia, Rhinorrhoea, Goosebumps
→ Resolves spontaneously, but can be medically supported with substitute drug e.g. Methadone, Buprenorphine

N.B. Opioid toxicity is parasympathetic so everything goes down e.g. small pupils, respiratory depression, constipation, brady etc. Withdrawal is sympathetic, so has the opposite effects.

Question 3

What are the 2 rare, but life-threatening complications drug-induced disorders? How do they differ?

Answer 3

• Neuroleptic Malignant Syndrome (NMS) - Caused by antipsychotics (e.g. haloperidol). Characterised by ‘lead-pipe’ rigidity and hyporeflexia days to wks after the drug is taken.
• Serotonin syndrome - Caused by serotonergic agents (e.g. citalopram). Characterised by hyperreflexia and clonus hrs after the drug is taken.

N.B. NMS involves the breakdown of muscles, therefore CK is raised and can be used as a diagnostic tool.